Safety and OSHA News

Did his job cause blood clot?

It can be difficult to determine whether work caused an employee’s injury for things like back strain. This case involves a blood clot. Did the employee get workers’ comp? 

One day while on the road, George Wingfield, a truck driver for Hill Brothers Transportation in Nebraska, developed chest pains. He was hospitalized and diagnosed with deep vein thrombosis (a type of blood clot) in his left leg and the likely presence of a pulmonary embolism.

When a blood clot breaks off, it may travel through the heart and enter the lung system. A pulmonary embolism occurs when the blood clot reaches a point in a lung artery where it can’t pass through and becomes lodged.

Pulmonary embolism can be fatal. Sedentary jobs can contribute to the condition.

Wingfield received a filter implant to prevent future embolisms. He returned to work but needed more frequent rest breaks. He eventually stopped working for Hill when he injured his back in a fall from his truck.

The truck driver applied for workers’ comp coverage in connection with the embolism.

This wasn’t Wingfield’s first diagnosis of thrombosis and embolism. As a result, anticoagulant medication had been prescribed for him to prevent more blood clots from forming.

The case went before a workers’ compensation court. The court noted Wingfield’s previous episodes required it to consider what level of proof was necessary to show his injuries arose out of employment.

The compensation court chose to use the same test that had been established in Nebraska to determine whether a heart attack was work-related.

After applying the test, the court determined Wingfield failed to prove that his employment contributed in some substantial way to cause his injury.

A doctor testified Wingfield was “not adequately anticoagulated” when he was admitted to the hospital with the most recent thrombosis and embolism. Tests showed the level of anticoagulant medication in his system was “consistent with a person who was not taking any type of anticoagulation medication.”

Given that medical testimony, the compensation court ruled Wingfield had failed to prove his case and dismissed his appeal. Wingfield appealed, and now the Nebraska Supreme Court has weighed in.

Correct test used?

Wingfield argued the compensation court shouldn’t have used the heart attack test in his case.

The NE Supreme Court noted:

“An exertion- or stress-related heart injury to which the claimant’s preexisting heart disease or condition contributes is compensable only if the claimant shows that the exertion or stress encountered during employment is greater than that experience during the ordinary nonemployment life of the employee or any other person.”

The court also noted that medical causation is the biggest problem in determining whether heart attack cases are eligible for workers’ comp benefits. “This is because the generalized nature of heart attack cases makes it difficult to attribute the attack to the work,” the court wrote.

In Nebraska, the test used for heart attack cases had also been used for cases of stroke because the same problem exists … proving whether work caused the stroke.

“We see the same problem of proving causation in Wingfield’s injuries of deep vein thrombosis and pulmonary embolism,” the NE Supreme Court said.

After determining that the compensation court used the correct test, the NE Supreme Court could focus on whether the actual ruling in the case was correct.

The state’s highest court found the compensation court properly found the testimony of the doctor to be convincing – that the primary and most likely cause of Wingfield’s thrombosis and embolism was inadequate level of anticoagulation.

For that reason, the Nebraska Supreme Court affirmed the compensation court’s dismissal of Wingfield’s workers’ comp claim on the basis that he didn’t show his injuries were work-related.

What do you think about the court’s ruling? Let us know in the comments section.

(George Wingfield v. Hill Brothers Transportation, Nebraska Supreme Court, No. S-13-716, 5/16/14)


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